What are the other Names for this Condition? (Also known as/Symptoms)

• Ovarian Teratoma

What is Teratoma of Ovary? (Definition/Background Information)

• Teratoma of Ovary is a rare type of ovarian tumor that arises from the germ cells. It is usually observed in adolescent and young women
• The following forms of Ovarian Teratomas have been described: 
  • Mature teratoma of ovary: It is made up of cells that resemble adult tissue cells. Most teratomas belong to the mature type
  • Immature teratoma of ovary: It is made up of cells that resemble an embryo, or developing fertilized egg
  • Dermoid cyst of ovary: It is a type of mature cystic teratoma. However, unlike mature cystic teratoma that consist of tissues from the germ layer, a dermoid cyst has only skin and adnexal structures
  • Monodermal teratoma of ovary: It is a teratoma showing only a single tissue type (such as thyroid tissue, nerve tissue, etc.)
• Teratoma of Ovary may be cancerous or benign. A majority of benign teratomas are mature, while a majority of malignant teratomas are immature. Most teratoma tumors are either mature or immature
• Teratoma can have tissue from anywhere in the body. The cause of formation of Teratoma of Ovary is unknown. Also, presently the risk factors for the same are not well-established
• In many cases, no signs and symptoms of teratoma are observed and these tumors are diagnosed incidentally. Some tumors may grow to large sizes and cause obstructive signs and symptoms. Also, malignant Ovarian Teratomas may metastasize to distant organs
• The treatment of Teratoma of Ovary involves surgery in most cases. Immature teratomas may be additionally treated using chemotherapy and/or radiation therapy
• In a majority of cases, the prognosis of mature teratoma is excellent with early appropriate treatment. However, the prognosis of immature teratoma depends upon various factors and can be only assessed on a case-by-case basis

Notes on germ cells:

• Germ cells are one of the two types of cells in the body. They form sex cells - the sperms and eggs, while the other type, the somatic cells, forms everything else (i.e., all other body organs and parts)
• Normal germ cells arise from pluripotent stem cells. Pluripotent stem cells can differentiate into, or become, any cell in the body. Thus, pluripotent stem cells may become either germ cells or somatic cells
• The process of pluripotent stem cells becoming other cell types is mediated by chemical signalling. Chemicals that act as signals include growth factors, nutrients, and hormones
• Stem cells that do not respond to normal signals may grow uncontrollably and cause tumors. This tumor-causing potential makes them “neoplastic”. Neoplastic cells that grow aggressively and spread to other areas are cancerous

Who gets Teratoma of Ovary? (Age and Sex Distribution)

• Teratoma of Ovary is mostly observed in females below the age of 30 years. These tumors are often seen in young adolescent girls and women
• No specific racial or ethnic group predilection is noted

What are the Risk Factors for Teratoma of Ovary? (Predisposing Factors)

• Currently, no definite risk factors have been identified for Ovarian Teratomas

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Teratoma of Ovary? (Etiology)

The cause of development of Teratoma of Ovary is generally unknown. It is believed that abnormal differentiation of germ cells gives rise to the formation of this tumor.

• In general, it is known that cancers form when normal, healthy cells begin transforming into abnormal cells - these cancer cells grow and divide uncontrollably (and lose their ability to die), resulting in the formation of a mass or a tumor
• The transformation of normally healthy cells into cancerous cells may be the result of genetic mutations. Mutations allow the cancer cells to grow and multiply uncontrollably to form new cancer cells
• These tumors can invade nearby tissues and adjoining body organs, and even metastasize and spread to other regions of the body

What are the Signs and Symptoms of Teratoma of Ovary?

The signs and symptoms of Teratoma of Ovary depend on the subtype of the tumor. It may vary from one girl or women to another. In general, most (small) tumors are asymptomatic and no significant symptoms are observed, while large tumors are known to present symptoms.

The signs and symptoms of Teratoma of Ovary include the following:

• Presence of a well-circumscribed tumor in the ovary; mature teratomas are generally benign
• Immature teratomas may be solid and locally invasive
• Generally, only one ovary is affected; but, in nearly 10-15% of the cases, involvement of both ovaries may be seen (bilateral Ovarian Teratoma)
• The tumors may range in size from a few cm to over 25 cm
• Usually immature teratomas are larger in size (14-25 cm) than mature teratomas (7 cm average)
• Large tumors (size over 4 cm) can compress the surrounding structures or organs and give the sensation of an abdominal mass
• Abdominal pain from large-sized ovarian tumors
• Abdominal discomfort, heaviness, and tenderness (especially at the iliac fossa, which is an area near to the hip bone)
• Pelvic discomfort and pain; lower back pain
• Frequent urination due to compression/pressure of the tumor
• When metastasis is noted, it may result in weight loss, fatigue, and other systemic symptoms

How is Teratoma of Ovary Diagnosed?

There are a variety of tests the healthcare provider may employ to diagnose Teratoma of Ovary, which may include:

• Physical examination and complete medical history screening
• Assessment of the symptoms observed
• Blood tests for various markers
• Alpha fetoprotein (AFP) blood test
• Ultrasound scan of the pelvis: It is a non-invasive procedure that uses high frequency sound waves to produce real-time images
• Transvaginal ultrasound: An ultrasound is inserted into the vagina and the mass is examined using sound waves
• Abdominal and pelvic CT scan: It is a non-invasive procedure that provides more details of soft tissues, blood vessels, and internal organs
• Pelvic MRI scan: It is a non-invasive medical test that uses a powerful magnetic field to produce images of soft tissues, bones, organs, and all other internal structures of the abdomen and pelvis
• Hysteroscopy: This procedure involves placing a probe through the cervix to examine the cavity of the uterus

Invasive diagnostic procedures such as:

• Laparoscopy: A special device is inserted through a small hole into the abdomen, to visually examine it. If necessary, a tissue sample is obtained for further analysis. Exploration of the abdomen using a laparoscope is called ‘exploratory laparoscopy’
• Laparotomy: The abdomen is opened through an incision for examination, and if required, a biopsy sample obtained. Exploration of the abdomen using laparotomy procedure is called ‘exploratory laparotomy’

Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment. The tissue for diagnosis can be procured in multiple different ways which include:

• Fine needle aspiration (FNA) biopsy of the tumor: A FNA biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy is preferred
• Core biopsy of the tumor
• Open biopsy of the tumor

Tissue biopsy:

• A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
• Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
• The tumors may have varying proportions of blood vessels, smooth muscle, and fat cells, when examined by a pathologist under a microscope
• Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis

A differential diagnosis to eliminate other tumor types may be necessary prior to establishing a definite diagnosis. The following tumors may be excluded:

• Hemorrhagic ovarian cyst
• Endometrioma of ovary

Note:

• A majority of Ovarian Teratoma tumors are discovered incidentally
• Some tumors may show tooth components and calcification
• Depending on the type of malignancy arising in immature teratoma, blood tests may show elevation of certain enzymes such as alpha fetoprotein

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Teratoma of Ovary?

The complications of Teratoma of Ovary may depend on the subtype of the tumor, whether benign or malignant, and may include the following:

• Stress and anxiety due to fear of cancer of the ovary
• Large tumor masses may get secondarily infected with bacteria or fungus
• Tumor rupture and torsion:
  • Rupture of tumor can cause peritonitis
  • Usually, larger tumors are more prone for torsion
  • Ovarian torsion can result in acute abdominal pain and a surgical emergency
• Some immature teratomas are known to rupture and cause associated complications
• Some teratomas are known to transform to malignancies; 1-2% may undergo malignant transformation
• Metastasis of immature or malignant teratoma to distant sites
• Recurrence of the tumor following its incomplete surgical removal: Immature forms are more often likely to recur than mature forms
• Malignant teratomas are most commonly squamous cell carcinomas, sarcomas, or adenocarcinomas

There may be complications related to the methods used in treating the condition and may include:

• Side effects of radiation therapy that may include sunburn-like rashes, where radiation was targeted, red or dry skin, heaviness of the breasts, and general fatigue
• Side effects of chemotherapy, which may include nausea, vomiting, hair loss, decreased appetite, mouth sores, fatigue, low blood cell counts, and a higher chance of developing infections
• The treatment can also cause infertility in men and women. Hence, measures to protect the individual’s fertility must be considered, before starting chemotherapy
• Damage to the muscles, vital nerves, and blood vessels, during surgery
• Post-surgical infection at the wound site is a potential complication

How is Teratoma of Ovary Treated?

The treatment of Teratoma of Ovary may involve the following:

• Generally, the treatment of choice is complete surgical excision for all teratomas (mature or immature). The following surgical procedures may be considered:
  • Operative laparoscopy
  • Cystectomy or surgical removal of the ovarian cyst
  • Oophorectomy or removal of the affected ovary
  • Ovarian tissue sparing techniques
• However, while it is usually possible to surgically remove a mature teratoma, the complete removal of an immature teratoma may be challenging
• Additionally, chemotherapy and/or radiation therapy may be necessary for malignant teratomas
• Follow-up care with regular screening and check-ups are important and encouraged

How can Teratoma of Ovary be Prevented?

Currently, there are no known methods to prevent the development of Teratoma of Ovary.

What is the Prognosis of Teratoma of Ovary? (Outcomes/Resolutions)

• The prognosis of Ovarian Teratoma depends upon whether it is a mature or immature type (also, whether the tumor is benign or malignant)
  • Many of the tumors are mature teratomas that behave in a benign manner. With complete surgical removal of the tumor, the prognosis is typically excellent
  • Immature teratomas may be aggressive, difficult to treat (complete tumor resection may not be possible), and can spread to other sites. The prognosis of these tumors is usually adjudged on a case-by-case basis
• If immature teratomas can be completely removed through surgery, then the prognosis is generally improved
• Occasionally, with chemotherapy, an immature teratoma can convert into a mature teratoma. Such mature teratomas can remain stable for prolonged periods - this is called retroconversion of an immature teratoma to a mature teratoma. A retroconverted teratoma can remain stable in size, but needs to be regularly monitored

Additional and Relevant Useful Information for Teratoma of Ovary:

The following article link will help you understand other cancers and benign tumors:

http://www.dovemed.com/diseases-conditions/cancer/